INTERLIBRARY SERVICES, 133 DOE LIBRARY, UNIVERSITY OF CALIFORNIA, BERKELEY CA 94720-6000

Baker Individual Subscription Form - Deposit Account

INSTRUCTIONS:
Complete form, enclose payment, and send to:
        BAKER Service, 133 Library, Campus 6000
Minimum deposit is $25.00 - submitted in one of the following forms:
    1. A personal check payable to "The Regents of UC"
    2. An Interdepartmental Order and Charge Form (IOC) made out to "BAKER Service"
    3. Circle one:  VISA/MASTERCARD/DISCOVER/ATM [ ___ VISA ___ MASTERCARD]

Amount of charge $____________________ 

Name as it appears on the card____________________

Card number__________________________

Expiration date _____/_____(mm/yy)



___________________________________
Last name, First name


___________________________________
Department

___________________________________
Delivery Address (mail box or in-box)

_________________/_________________
Contact Person / Telephone # or e-mail

_________________/_________________
Office Phone / Message Phone or e-mail


Library Status (Please circle one):      Faculty      Staff      Graduate      PhD Candidate

Please check one regarding Interlibrary Borrowing referral:
___ Refer request to Interlibrary Borrowing automatically if material requested is not at UCB.
___ I will decide on Interlibrary Borrowing referral on a case-by-case basis.

Please check one regarding article delivery:
___ I would like my articles delivered on the Web.
___ I would like my articles delivered in hard copy to my mailbox.

Please read, fill in amount($), and sign in order to establish your account:

My initial deposit is in the amount of $ ___________. I understand that these funds are not refundable, and that if my BAKER account is inactive for a full academic year (July 1 - June 30), my account is subject to closure and the balance forfeited. I hereby authorize the BAKER service to act as my proxy borrower in the Library at UC Berkeley. I agree to use BAKER only for my own research needs, and in compliance with the Library rules and policies. When requesting photocopies, I accept full responsibility for compliance with the copyright law of the United States (Title 17 U.S. Code).


__________________________________
Signature


__________________________________
Date


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The Regents of the University of California. All rights reserved.
Last updated 07/06/11. Content maintained by: Interlibrary Services staff.